New AD consensus elevates advanced topical nonsteroidals to first-line status
Emphasis on reduced steroid burden is especially relevant in skin of colour, where erythema may be less apparent and dyspigmentation should be considered (Issue #530, 1,600 words, 8 minutes)
Advanced topical nonsteroidal therapies should now be viewed as core components of atopic dermatitis management, rather than marginal steroid-sparing adjuncts, according to a consensus report authored by Dr. April W. Armstrong [pictured below] and colleagues, just published in the Journal of Drugs in Dermatology.
For dermatologists treating patients with skin of colour, the paper has particular clinical resonance. Although the consensus is not exclusively focused on skin of colour, its emphasis on durable itch control, improved sleep, better quality of life, reduced relapse frequency, and lower cumulative steroid exposure aligns closely with the challenges of AD in darker phototypes. In richly pigmented skin, erythema may be less conspicuous, morphology may be papular, follicular, lichenoid, or psoriasiform, and post-inflammatory dyspigmentation may remain a major source of morbidity even after inflammation improves.
In that setting, the panel’s endorsement of nonsteroidals for sensitive and high-impact sites is especially relevant, since under-treatment and steroid hesitancy can both prolong disease activity and pigmentary sequelae.
The consensus also makes a workflow argument: these agents were viewed as having favorable safety and tolerability profiles and generally not requiring baseline or ongoing laboratory monitoring, which may simplify prescribing relative to many systemic approaches. The panel also supports their incorporation into combination treatment plans with topical or systemic therapies, a point that reflects real-world practice where residual facial, intertriginous, hand, or localized recalcitrant disease often persists despite broader disease control.
Bottom line: Simplified dosing, site flexibility, and steroid-sparing durability may prove just as relevant as efficacy when deciding where therapies fit in an individualized AD algorithm.
From the literature on dermatology in skin of colour
Dermocosmetics in acne vulgaris: South African consensus recommendations with a focus on skin of colour
Researchers developed expert consensus recommendations for the use of dermocosmetics in the management of acne vulgaris in the South African context.
They developed their recommendations through a combination of structured expert meetings and a targeted literature review of current international and local evidence. The panel synthesized clinical experience and research findings to identify key principles for selecting and integrating dermocosmetics into acne treatment regimens.
In their conclusions, the authors write that for patients with skin of colour, dermocosmetic formulations that protect against visible light, promote pigmentary evenness, and maintain barrier integrity are particularly valuable. They recommend that cosmetic counselling should also form part of holistic acne care, incorporating guidance on dermocosmetic use, makeup, and culturally relevant haircare practices. A personalized approach to DC selection and use can optimize clinical outcomes, improve quality of life, and address the unique needs of diverse patient populations.
The consensus provides practical recommendations for dermocosmetic use as adjunctive therapy, monotherapy in mild cases, and maintenance therapy to sustain remission.
A cross-sectional pilot study evaluating the histopathology of atrophic acne scars with a focus on the vertical depth of ice pick, boxcar, and rolling scars and its implications in skin of colour
This study assessed the histological changes in atrophic acne scars and determined the vertical depth of each scar type, with a consideration to skin of colour.
Investigators biopsied 32 boxcar, 10 ice-pick, and seven rolling scars. They stained tissue samples with hematoxylin and eosin, Verhoeff-van Gieson, and Masson’s trichrome stains. Researchers identified acne scars based on morphological changes in collagen and elastin, loss of pilosebaceous units in the scar area, and tilting of follicular units in the adjoining dermis. The depth of the scars was measured in µm. Participants included 31 males, 17 females, and 1 transgender patient, with ages ranging from 18 to 35 years. The patients had Fitzpatrick skin phenotypes IV to VI.
The investigators found atrophic acne scars revealed loose, haphazardly arranged collagen (71%) and reduced elastic tissue (96%). They noted appendageal tilting in 44/49 (90%) biopsies, with consistent pilosebaceous unit loss in the scar. Mean depths of ice-pick, boxcar, and rolling scars were 1,933.4±1,117.8 µm, 1,327.88±571.34 µm, and 1,357.14±578.3 µm, respectively. There was a significant difference in the mean depth of scars between ice-pick and boxcar scars (p=0.02). Additional findings noted were scar vascularisation (n=46), ectatic channels in the scar (n=18), mononuclear inflammatory infiltrates (n=43), calcinosis (n=3), demodex mites (n=2), solar elastosis (n=2), pigment-laden macrophages (n=2), granulomatous perifolliculitis (n=4), and pulled-up eccrine glands (n=8).
The authors concluded that, based on existing data, the dose of fractional carbon dioxide laser should be set to achieve an approximate depth of 1,933.4 µm to address all atrophic scars.
Prospective evaluation of a fractional 675-nm nonablative laser for atrophic acne scars in Fitzpatrick skin types III-IV
In this study, 16 adults with Fitzpatrick skin types III to IV and atrophic acne scars (AAS) underwent three monthly treatment sessions with a nonablative 675-nm laser, using the sequential Moveo (low-fluence scanning) and Standard (fractional stamping) modes. Researchers assessed outcomes at baseline and at 1, 3, and 6 months after the final session, including Goodman and Baron quantitative scores (GBQGASGS), Antera 3D imaging device, patient satisfaction, procedural pain, and adverse events.
GBQGASGS improved by 14.5% at 6 months after the final treatment (19.81±7.31 to 16.94±7.18; p=0.001), with a 9.7% reduction evident 1 month after the second session (p=0.017). Antera 3D analysis demonstrated improvements in skin texture (12.91 ± 4.25 to 11.38 ± 3.97; p = 0.002) and scar volume (2.54 ± 1.33 to 2.04 ± 1.26; p = 0.001). At 6 months, blinded evaluators reported ≥ 25% improvement in 50% of subjects, while 69% of patients reported ≥ 25% improvement. Adverse events were of low incidence and transient, and no serious complications occurred.
At the intersection of skin and society
The Canadian federal government says it is expanding a series of career development, leadership, and mental health initiatives for Black public servants, as part of its multi‑year Action Plan for Black Public Servants, reports Canadian HR Reporter.
According to the Treasury Board of Canada Secretariat, the number of Black mental health professionals available through Health Canada’s Employee Assistance Program tripled to 122 as of December 2025, serving Black public servants and their immediate family members.
The Secretariat also reported that 199 Black public servants have received leadership development services through the enhanced Career Counselling and Coaching program, with another 200 participants continuing into the new fiscal year. Some 50 Black executives have completed the Executive Leadership Development Program, with an additional 47 participants expected to finish by April 2026, bringing the total to 97 graduates.
Another 92 employees are expected to complete the Aspiring Directors Program for Black Leaders by March 2026.
“These efforts help support Black employees in the public service so that they can succeed,” said Shafqat Ali, president of the Treasury Board, in an official statement. “This ongoing work supports a safe, healthy and inclusive workplace where everyone can thrive across the government of Canada.”
Other supports include a Black Mental Health Webinar Series to explore mental health and systemic racism in the workplace, the Second Official Language Training for Black Public Servants, the Supporting Future Innovators Program, and the Building the Pipeline initiative that is designed to strengthen training and capacity in the offices of Ombuds and Informal Conflict Management Services to improve conflict resolution and employee support services for Black public servants.
This week
March 8-14 is Patient Safety Awareness Week
March 12 is National Skin Barrier Day in the U.S.
March 15 is International Day to Combat Islamophobia
Something to think about in the week ahead . . .
—Emile Hirsch, (1985-present), U.S. actor
Next week
During a presentation at the 2025 Skin Spectrum Summit in Toronto, Dr. Joël Claveau (Quebec City), reviewed the clinical and dermoscopic diagnosis of skin cancer in patients with skin of colour.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portals?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dermatologists Dr. Hadar Lev-Tov (Miami) and Dr. Robert S. Kirsner (Miami) review innovations in wound care.
Drs. Melinda Gooderham (Peterborough, Ont.), Mark Kirchhof (Ottawa), Jensen Yeung (Toronto), and Jessica Asgarpour (Toronto) review new medications that entered Canadian dermatologists’ toolboxes in 2025.
Dr. Jeffrey Marcus Cohen (New Haven, Conn.) provides insight into anticipating and managing paradoxical reactions when treating psoriasis and AD patients with advanced medications.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast, featuring Dr. Ron Vender, has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences the severity of psoriasis, sex differences in psoriatic inflammation and itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.